Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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Lipid-cell variant Very infrequently urothelial carcinomas contain abundant lipid in which lipid distended cells mimic signet ring cell adenocarcinoma {1798}. The differential diagnosis is typical liposarcoma and signet ring cell carcinoma. A C Fig. 2.17 A, B Infiltrating urothelial carcinoma of the bladder. Sarcomatoid variant with heterologous elements of osteosarcoma and myxoid sarcoma. C, D Infiltrating urothelial carcinoma of the bladder. Sarcomatoid variant with heterologous elements of chondrosarcoma showing binucleation and atypical chondrocytes within lacunae. Urothelial carcinoma with trophoblastic differentiation Trophoblastic differentiation in urothelial carcinoma occurs at different levels. High grade invasive urothelial carcinomas may express ectopic human chorionic gonadotropin (HCG) and other placental glycoproteins at the immunohistochemical level only or may contain numerous syncytiotrophoblastic giant cells {365,656,925,2891}. Very rarely, choriocarcinomatous differentiation has been reported. B D Clear cell variant The clear cell variant of urothelial carcinoma is defined by a clear cell pattern with glycogen-rich cytoplasm {1365, 1954}. The clear cell pattern may be focal or extensive and awarness of this pattern is important in differential diagnosis with clear cell adenocarcinoma of the urinary bladder and metastatic carcinoma from the kidney and prostate. The pattern may be seen in typical papillary or in situ lesions, but is relatively more common in poorly differentiated urothelial carcinomas. Undifferentiated carcinoma This category contains tumours that cannot be otherwise classified. In our experience, they are extremely rare. Earlier the literature has included small cell carcinoma, giant cell carcinoma, and lymphoepithelioma-like carcinoma in this category, but these tumours are now recognized as specific tumour variants {656,1553}. Large cell undifferentiated carcinoma as in the lung is rare in the urinary tract, and those with neuroendocrine features should be recognized as a specific tumour variant {2816}. Genetic susceptibility Urothelial carcinoma is not considered to be a familial disease. However numerous reports have described families with multiple cases {1313,1669}. There is strong evidence for an increased risk of ureteral and renal pelvic urothelial carcinomas, but not bladder cancers, in families with hereditary nonpolyposis colon cancer {2411,2789}. In addition several epidemiological studies showed that urothelial carcinomas have a familial component with a 1.5 to 2-fold increased risk among first-degree relatives of patients {23,905, 1312,1387}. The only constitutional genetic aberration demonstrated so far in a family with urothelial carcinomas in two generation was a t(5;20)(p15;q11) balanced translocation {2336}. No chro- A B Fig. 2.18 A Urothelial carcinoma, high grade with giant cells of osteoclastic type. B Giant cells in Infiltrating urothelial carcinoma of the bladder. Infiltrating urothelial carcinoma 103
A B Fig. 2.19 A Infiltrative urothelial carcinoma. Urothelial carcinoma with trophoblastic differentiation. B Trophoblastic differentiation of urothelial cell carcinoma. Syncytiotrophoblastic malignant cells with high grade urothelial cancer. C Infiltrative urothelial carcinoma. Urothelial carcinoma with trophoblastic differentiation, HCG immunostaining. C mosomal alterations were found in 30 additional families with at least 2 affected individuals {22}. Interestingly, patients with sporadic urothelial carcinomas revealed a higher mutagen sensitivity than controls whereas patients with hereditary bladder cancer demonstrated no increased mutagen sensitivity {21}. A small increase in bladder cancer risk was demonstrated for polymorphic variants of several detoxifying enzymes, like NAT2 and GSTM1 {700,1624}. A Fig. 2.20 Infiltrative urothelial carcinoma. A Clear cell variant of urothelial carcinoma of the urinary bladder. B Clear cell variant of urothelial carcinoma of the urinary bladder. A C Fig. 2.21 Infiltrative urothelial carcinoma. A, B Urothelial carcinoma, lipoid cell variant showing the characteristic lipoblast-like features of proliferating cells (H&E). C Urothelial carcinoma, lipoid cell variant with immunohistochemical expression of cytokeratin 7 in most proliferating cells. D Urothelial carcinoma, lipoid cell variant with immunohistochemical expression of epithelial membrane antigen. B B D Somatic genetics The genetic studies to date have used tumours classified according to WHO Tumours Classification (1973) and further studies are underway to link available genetic information to the current classification. It is assumed that invasive urothelial cancers are mostly derived from either non-invasive high grade papillary urothelial carcinoma (pTaG3) or urothelial carcinoma in situ. On the genetic level invasively growing urothelial cancer (stage pT1-4) is highly different from low grade non-invasive papillary tumours (Papillary Urothelial Neoplasm of Low Malignant Potential, Non-Invasive Low Grade Papillary Urothelial Carcinoma). Chromosomal abnormalities Invasively growing urothelial bladder cancer is characterized by presence of a high number of genetic alterations involving multiple different chromosomal regions. Studies using comparative genomic hybridization (CGH) have described an average of 7-10 alterations in invasive bladder cancer {2188,2189, 2191,2418,2419}. The most frequently observed gains and losses of chromosomal regions are separately summarized for cytogenetic, CGH, and LOH (loss of heterozygosity). Taken together, the data highlight losses of 2q, 5q, 8p, 9p, 9q, 10q, 11p, 18q and the Y chromosome as well as gains of 1q, 5p, 8q, and 17q as most consistent cytogenetic changes in these tumours. The large size of most aberrations detected by CGH or cytogenetics makes 104 Tumours of the urinary system
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World Health Organization Classific
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This volume was produced in collabo
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Contents 1 Tumours of the kidney 9
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CHAPTER 1 Tumours of the Kidney Can
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TNM classification of renal cell ca
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one quarter of kidney cancers in bo
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Familial renal cell carcinoma M.J.
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Table 1.02 Genotype - phenotype cor
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A B Fig. 1.11 A Multiple cutaneous
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A B Fig. 1.14 Birt-Hogg-Dubé syndr
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Clear cell renal cell carcinoma D.J
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Fig. 1.20 Clear cell renal cell car
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Papillary renal cell carcinoma B. D
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A B Fig. 1.29 Papillary renal cell
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Fig. 1.33 Chromophobe RCC with sarc
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Carcinoma of the collecting ducts o
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Renal medullary carcinoma C.J. Davi
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Renal carcinomas associated with Xp
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Renal cell carcinoma associated wit
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Papillary adenoma of the kidney J.N
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of this tumour. Microscopic extensi
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A B Fig. 1.59 Metanephric adenoma.
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esults in intratumoral aneurysms. O
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peritumoural fibrous pseudocapsule.
Page 49 and 50: increases in prevalence to approxim
Page 51 and 52: Nephrogenic rests and nephroblastom
Page 53 and 54: Cystic partially differentiated nep
Page 55 and 56: A B Fig. 1.80 Clear cell sarcoma of
Page 57 and 58: A B Fig. 1.85 Rhabdoid tumour of th
Page 59 and 60: transcription factor is fused to th
Page 61 and 62: Leiomyosarcoma S.M. Bonsib Definiti
Page 63 and 64: Angiomyolipoma G. Martignoni M.B. A
Page 65 and 66: melanocytic and smooth muscle marke
Page 67 and 68: Multinucleated and enlarged ganglio
Page 69 and 70: Haemangioma P. Tamboli Definition H
Page 71 and 72: Fig. 1.107 Juxtaglomerular cell tum
Page 73 and 74: Intrarenal schwannoma I. Alvarado-C
Page 75 and 76: Mixed epithelial and stromal tumour
Page 77 and 78: Synovial sarcoma of the kidney J.Y.
Page 79 and 80: Renal carcinoid tumour L.R. Bégin
Page 81 and 82: Primitive neuroectodermal tumour (E
Page 83 and 84: Paraganglioma / Phaeochromocytoma P
Page 85 and 86: Leukaemia A. Orazi Interstitial inf
Page 87 and 88: WHO histological classification of
Page 89 and 90: TNM classification of carcinomas of
Page 91 and 92: The risk of bladder cancer goes dow
Page 93 and 94: Tumour spread and staging Urinary b
Page 95 and 96: feature in such patients undergoing
Page 97 and 98: A Fig. 2.12 Infiltrative urothelial
Page 99: A Fig. 2.15 A Infiltrating urotheli
Page 103 and 104: Fig. 2.23 Infiltrative urothelial c
Page 105 and 106: ing systems have been proposed on t
Page 107 and 108: Non-invasive urothelial tumours G.
Page 109 and 110: chronically inflamed urothelium and
Page 111 and 112: Inverted papilloma G. Sauter Defini
Page 113 and 114: muscle invasive disease, but there
Page 115 and 116: Fig. 2.42 Non-invasive urothelial n
Page 117 and 118: A Fig. 2.45 Non-invasive urothelial
Page 119 and 120: for DBCCR1 silencing {984,2476}. Th
Page 121 and 122: Squamous cell carcinoma D.J. Grigno
Page 123 and 124: Fig. 2.51 Squamous cell carcinoma.
Page 125 and 126: Adenocarcinoma A.G. Ayala P. Tambol
Page 127 and 128: A B Fig. 2.61 A Adenocarcinoma in s
Page 129 and 130: A B Fig. 2.65 Intramural urachal ca
Page 131 and 132: Müllerian origin is postulated for
Page 133 and 134: A Fig. 2.69 Small cell carcinoma. A
Page 135 and 136: Carcinoid L. Cheng Definition Carci
Page 137 and 138: Leiomyosarcoma J. Cheville Definiti
Page 139 and 140: Osteosarcoma L. Guillou Definition
Page 141 and 142: Leiomyoma J. Cheville Definition A
Page 143 and 144: Haemangioma L. Cheng Definition Hae
Page 145 and 146: Metastatic tumours and secondary ex
Page 147 and 148: Tumours of the renal pelvis and ure
Page 149 and 150: nodular, ulcerative or infiltrative
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Tumours of the urethra F. Hofstädt
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usually show enteric, colloid or si
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CHAPTER 3X Tumours of of the the Pr
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TNM classification of carcinomas of
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contrast, mortality among migrants
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Fig. 3.06 Transrectal ultrasound of
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PSA-related diagnostic strategies.
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A B C Fig. 3.10 A,B Section of pros
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pale-clear, similar to benign gland
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A B Fig. 3.20 A, B Adenocarcinoma w
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prostate adenocarcinomas exhibit AR
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A Fig. 3.27 A, B Foamy gland adenoc
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A B Fig. 3.32 A Sarcomatoid carcino
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A B Fig. 3.37 A Gleason score 1+1=2
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A B Fig. 3.43 A Prostate cancer Gle
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Fig. 3.48 Heat map-nature. From S.M
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Fig. 3.51 Prostate cancer. Major su
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many stage T1b cancers. Stage T2 Mo
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Fig. 3.58 Patterns of seminal vesic
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Prostatic intraepithelial neoplasia
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A B Fig. 3.63 A Micropapillary high
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A B Fig. 3.68 A Ductal carcinoma in
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Ductal adenocarcinoma X.J. Yang L.
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Papillary pattern can be seen in bo
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A B Fig. 3.74 A Inflammation withou
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Squamous neoplasms T.H. Van der Kwa
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Neuroendocrine tumours P.A. di Sant
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Mesenchymal tumours J. Cheville F.
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Fig. 3.89 Sarcoma of the prostate.
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Miscellaneous tumours P.H. Tan L. C
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A Fig. 3.96 A Adenocarcinoma of the
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WHO histological classification of
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Introduction F.K. Mostofi I.A. Sest
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wartime birth cohorts illustrate th
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Similar tumours as those of group 1
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crucial for the development of this
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A B Fig. 4.09 Spermatocytic seminom
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A B Fig. 4.14 Intratubular germ cel
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A B Fig. 4.19 Seminoma. A Typical s
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Fig. 4.24 Seminoma. Vascular invasi
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Fig. 4.28 Spermatocytic seminoma wi
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A B Fig. 4.33 Embryonal carcinoma.
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A B Fig. 4.38 Yolk sac tumour. A En
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have cytoplasmic lacunae that conta
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A Fig. 4.46 Teratoma. A Longitudina
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A B Fig. 4.51 A Cut surface of derm
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Fig. 4.54 Mixed germ cell tumour. L
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Sex cord / gonadal stromal tumours
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A B C Fig. 4.67 Malignant Leydig ce
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A Fig. 4.73 A Sertoli cell tumour.
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ICD-O codes Granulosa cell tumour 8
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ICD-O code 8592/1 Clinical features
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A B Fig. 4.83 Germ cell-sex cord/go
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A Fig. 4.85 A, B Brenner tumour of
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typical grade III follicular morpho
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testicular parenchyma and tumour te
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A B the surgical scar and adjacent
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Immunoprofile Ordóñez and associa
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often have a grey-white cut surface
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Fig. 4.111 Angiomyofibroblastoma-li
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A B Fig. 4.119 Embryonal rhabdomyos
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Table 4.05 Secondary tumours of the
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WHO histological classification of
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A Fig. 5.04 A, B Squamous cell carc
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deformed by an exophytic mass. In s
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A B C Fig. 5.12 A Warty (condylomat
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A Fig. 5.20 Bowenoid papulosis. A,
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three had been circumcized by 9 yea
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Mesenchymal tumours J.F. Fetsch M.
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Fig. 5.31 Neurofibroma of the penis
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oectodermal tumour/Ewing sarcoma [p
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Secondary tumours of the penis C.J.
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Dr John N. EBLE* Dept. of Pathology
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Dr Ricardo PANIAGUA Department of C
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Source of charts and photographs 1.
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References 1. Anon. (1955). Case re
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115. Ariel I, Sughayer M, Fellig Y,
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246. Birt AR, Hogg GR, Dube WJ (197
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374. Cardone G, Malventi M, Roffi M
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502. Corti B, Carella R, Gabusi E,
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633. Donhuijsen K, Schmidt U, Richt
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768. Fischer J, Palmedo G, von Knob
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900. Goedert JJ, Cote TR, Virgo P,
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1028. Hartmann A, Dietmaier W, Hofs
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1162. Iezzoni JC, Fechner RE, Wong
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1293. Keetch DW, Catalona WJ (1995)
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1424. Ladanyi M, Lui MY, Antonescu
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1548. Lopez-Beltran A, Croghan GA,
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1681. McLaughlin JK, Silverman DT,
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1816. Moudouni SM, En-Nia I, Rioux-
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1945. Ohori M, Wheeler TM, Kattan M
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2070. Phillips G, Kumari-Subaiya S,
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2199. Riou G, Barrois M, Prost S, T
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2327. Schmidt L, Junker K, Weirich
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2450. Smith G, Elton RA, Beynon LL,
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2572. Tamboli P, Mohsin SK, Hailema
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2693. van Echten J, Timmer A, van d
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2816. Wick MR, Berg LC, Hertz MI (1
Page 347 and 348:
2937. Zhuang Z, Park WS, Pack S, Sc
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CCNB, 226 CCND1, 105, 108 CCND2, 22
Page 351 and 352:
J Juvenile type granulosa cell tumo
Page 353 and 354:
Promoter methylation, 21 Prostate s
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Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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